Woolf Steven H, Masters Ryan K, Aron Laudan Y
Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Department of Sociology, Health and Society Program and Population Program, Institute of Behavioral Science, University of Colorado Population Center, University of Colorado Boulder, CO, USA.
BMJ. 2021 Jun 23;373:n1343. doi: 10.1136/bmj.n1343.
To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations.
Simulations of provisional mortality data.
US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity.
Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively.
Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles.
Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 80.54 years, respectively) to 3.05 years (78.74 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared.
The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.
评估2010 - 2018年以及2020年新冠疫情期间美国不同人群的预期寿命变化，并与其他同类国家的结果进行比较。
临时死亡率数据模拟。
2010 - 2018年及2020年的美国和其他16个高收入国家，按性别划分，包括按种族和民族对美国结果进行分析。
分别来自美国国家卫生统计中心和人类死亡率数据库的美国及其他16个高收入国家的数据。
按性别划分的出生时、25岁和65岁时的预期寿命，在美国还按种族和民族划分。分析排除了2019年，因为许多同类国家没有生命表数据。2020年的预期寿命是通过根据2020年估计的年龄别死亡率模拟生命表并允许10%的随机误差来估算的。2020年的估计值报告为中位数以及第5和第95百分位数。
2010年至2018年期间，美国与同类国家平均预期寿命的差距从1.88年（分别为78.66岁和80.54岁）扩大到3.05年（78.74岁和81.78岁）。2018年至2020年期间，美国的预期寿命下降了1.87年（降至76.87岁），是同类国家平均下降幅度（0.22年）的8.5倍，差距扩大到4.69年。2018年至2020年期间，美国少数族裔群体的预期寿命下降幅度不成比例，西班牙裔、非西班牙裔黑人及非西班牙裔白人人口的预期寿命分别下降了3.88年、3.25年和1.36年。在西班牙裔和非西班牙裔黑人人口中，预期寿命的下降分别是同类国家平均水平的18倍和15倍。2010年以来美国黑人和白人之间预期寿命差距缩小的进展在2018 - 2020年被抹去；黑人男性的预期寿命降至1998年以来的最低水平（67.73岁），西班牙裔长期以来的预期寿命优势几乎消失。
2018年至2020年期间，美国预期寿命的下降幅度比其他高收入国家大得多，西班牙裔和非西班牙裔黑人人口的损失尤为明显。美国长期存在且不断扩大的健康劣势、2020年的高死亡率以及对少数族裔群体持续存在的不公平影响可能是长期政策选择和系统性种族主义的产物。
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